Provider Demographics
NPI:1619911468
Name:ADVOCATE HEALTH AND HOSPITALS CORPORATION
Entity Type:Organization
Organization Name:ADVOCATE HEALTH AND HOSPITALS CORPORATION
Other - Org Name:GOOD SAMARITAN HOSP AMBLTRY PHCY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:CHIGANOS
Authorized Official - Suffix:
Authorized Official - Credentials:BS PHARMACY
Authorized Official - Phone:630-275-1283
Mailing Address - Street 1:3825 HIGHLAND AVE
Mailing Address - Street 2:SUITE 5F
Mailing Address - City:DOWNERS GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60515-1552
Mailing Address - Country:US
Mailing Address - Phone:630-971-5878
Mailing Address - Fax:630-275-5868
Practice Address - Street 1:3825 HIGHLAND AVE
Practice Address - Street 2:SUITE 5F
Practice Address - City:DOWNERS GROVE
Practice Address - State:IL
Practice Address - Zip Code:60515-1552
Practice Address - Country:US
Practice Address - Phone:630-275-1283
Practice Address - Fax:630-275-5868
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-15
Last Update Date:2009-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0580072473336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL362169E11Medicaid
1444354OtherNCPDP PROVIDER IDENTIFICATION NUMBER
IL=========029Medicaid